Target blood pressure in diabetes patients with hypertension—What is the accumulated evidence in 2011?

There is overwhelming evidence that hypertension is an important risk factor for both macrovascular and microvascular complications in patients with diabetes, but the problem remains to identify appropriate goals for preventive therapies. A number of guidelines (the European Society of Cardiology (ESC)/European Association for the Study of Diabetes (EASD) 2007, the Joint National Committee (JNC)-VII 2003, the American Diabetes Association (ADA) 2011) have for example advocated a blood pressure goal of less than 130/80 mmHg, but this suggestion has been challenged by findings in recent trials and meta-analyses (2011). The European Society of Hypertension (ESH) therefore recommends a systolic blood pressure goal of “well below” 140 mmHg. Based on evidence from both randomized controlled trials (hypertension optimal treatment (HOT), action in diabetes and vascular disease: preterax and diamicron MR controlled evaluation (ADVANCE), action to control cardiovascular risk in diabetes (ACCORD)) and observational studies (ongoing telmisartan alone and in combination with ramipril global endpoint trial (ONTARGET), international verapamil-trandolapril study (INVEST), treat to new targets (TNT), and the National Diabetes Register (NDR)), it has been shown that the benefit for stroke reduction remains even at lower achieved blood pressure levels, but the risk of coronary events may be uninfluenced or even increased at lower systolic blood pressure levels. In a recent meta-analysis, it was therefore concluded that the new recommended goal should be 130–135 mmHg systolic blood pressure for most patients with type 2 diabetes. Other risk factors should also be controlled with a more ambitious strategy applied in the younger patients with shorter diabetes duration, but a more cautious approach in the elderly and frail patients with a number of vascular or non-vascular co-morbidities. In patients from East Asia, such as China, the stroke risk is relatively higher than the risk of coronary events. This must also be taken into consideration for individualized goal setting in relation to total risk, for example in patients from stroke-prone families. In conclusion, the current strategy is to have a more individualized approach to risk factor control in patients with type 2 diabetes, also relevant for blood pressure control.     

Tai Ji Quan as an exercise modality to prevent and manage cardiovascular disease: A review

BackgroundRegular exercise is beneficial for adults with cardiovascular disease (CVD) and CVD risk factors. Tai Ji Quan is popular among older adults and may offer additional exercise options. The present article aims to review the scientific literature published within the past decade on Tai Ji Quan as an exercise modality to prevent and manage CVD.MethodsAn electronic literature search of four databases (PubMed, CINAHL, PsycINFO, and AMED) was conducted from April 2003 through March 2013. Studies that examined Tai Ji Quan, were published in English, and specified a target study population of participants with a known CVD condition (e.g., coronary artery disease, chronic heart failure, or stroke) or studies conducted among participants with a CVD risk factor (e.g., hypertension, dyslipidemia, or impaired glucose metabolism) were included.ResultsA total of 20 studies met the inclusion criteria: 11 randomized clinical trials, seven quasi-experimental studies and two cross-sectional studies. The effect of Tai Ji Quan was examined on more than 20 different study variables among persons with coronary artery disease (n = 5 studies), chronic heart failure (n = 5 studies), stroke (n = 4 studies), and CVD risk factors (n = 6 studies). These studies were conducted primarily in Asia (n = 9, 45%) or the United States (n = 8, 40%). Overall, participants enrolled in Tai Ji Quan had better outcomes, though mixed results were reported.ConclusionCollectively, these studies indicate that Tai Ji Quan is a safe form of exercise to prevent and manage CVD. Further research is needed with more rigorous study designs, larger sample sizes, adequate Tai Ji Quan exercise doses, and carefully chosen outcome measures that assess the mechanisms as well as the effects of Tai Ji Quan, before widespread recommendations can be made.     

三种联合方案治疗轻中度高血压病疗效比较

目的比较三种二联用药方案治疗轻中度高血压病的疗效和安全性。方法随机开放对照试验,经2周安慰剂导入期,96例轻中度高血压病患者进入4周的治疗期,分三组对照用药。结果三组药物联用均能明显降低血压(P<0.01),总有效率分别为90.5%、93.6%、94.8%。结论对轻中度高血压病三种二联用药方案均安全、有效,每日一次能维持24小时降压效应,B、C组较A组为佳。     

Influence of serum adiponectin level and SNP +45 polymorphism of adiponectin gene on myocardial fibrosis

Adiponectin plays an important role in the development of hypertension, atherosclerosis, and cardiomyocyte hypertrophy, but very little was known about the influence of serum adiponectin or the adiponectin gene polymorphism on myocardial fibrosis. Our study investigates the influence of the SNP +45 polymorphism of the adiponectin gene and serum levels of adiponectin on myocardial fibrosis in patients with essential hypertension. A case-control study was conducted on 165 hypertensive patients and 126 normotensive healthy controls. The genotypes of adiponectin gene polymorphisms were detected by the polymerase chain reaction (PCR) method. Serum concentrations of procollagen were measured by a double antibody sandwich enzyme-linked immunosorbent assay (ELISA) in all subjects. The integrated backscatter score (IBS) was measured in the left ventricular myocardium using echocardiography. The serum levels of adiponectin in hypertensive patients were significantly lower than those in the normal control group ((2.69±1.0) μg/ml vs. (4.21±2.89) μg/ml, respectively, P<0.001). The serum levels of type-I procollagen carboxyl end peptide (PICP) and type-III procollagen ammonia cardinal extremity peptide (PIIINP) in the hypertension group were significantly higher than those in the control group. In the hypertension group, serum levels of adiponectin were significantly and negatively related to the average acoustic intensity and corrected acoustic intensity of the myocardium (r=0.46 and 0.61, respectively, P<0.05 for both). The serum levels of PICP and PIIINP were significantly different among the three genotypes of SNP +45 (P<0.01). Logistic regression analyses showed that sex and genotype (GG+GT) were the major risk factors of myocardial fibrosis in hypertensive patients (OR=5.343 and 3.278, respectively, P<0.05). These data suggest that lower levels of adiponectin and SNP +45 polymorphism of the adiponectin gene are likely to play an important role in myocardial fibrosis in hypertensive patients.     

Incidence of microalbuminuria in hypertensive patients

The prevalence of microalbuminuria was assessed in 174 albustix negative hypertensive patients by estimating albumin in the morning random urine samples by immunoturbidimetric method within four hours of voiding of urine. The urine samples were not stored and collected without any preservatives. The urinary albumin was calculated in terms of ratio with respect to urinary creatinine and expressed as albumin creatinine ratio (mg/g). Out of 174 albustix negative hypertensives, 58 (33.3%) patients were found to have microalbuminuria. The prevalence of microalbuminuria in males and females was found to be 34% and 30.7% respectively. No correlation was found between the Body Mass Index (BMI) and albumin excretion (r² = 0.0271) and between duration of hypertension and urinary albumin excretion (r² = 0.0042). Prevalence of microalbuminuria in nonsmokers and non-alcoholic hypertensives was 20%. The prevalence in alcoholics, smokers and both smokers and alcoholics was found to be 35%, 42% and 41% respectively. The high prevalence of microalbuminuria than the various reported studies on the subject demands establishment of a screening programme for microalbuminuria, implementation of specific intervention methods and education of hypertensive patients about the consequences of smoking and alcohol on possible involvement of renal system.     

高血压患者心功能变化的研究

目的研究高血压患者心功能的变化.方法常规心阻抗测定方法采用日本RM-6000多导生理记录仪.结果对394例心功能检查的结果进行分析高血压组检测SV、CO、CI、AC均明显低于正常,原发性高血压患者和临界高血压患者的SV、CO、CI、AC、TPR则无显著性差异.结论高血压患者在血压病理性升高过程中,早期心功能即发生异常变化,并在发展成高血压后一定时期内心功能保持稳定.     

Study of clinical features of amyloid angiopathy hemorrhage and hypertensive intracerebral hemorrhage

Objective: The purpose of this study was to differentiate between cerebral amyloid angiopathy (CAA) and hypertension (HTN) based on hemorrhage pattern interpretation. Methods: From June 1994 to Oct., 2000, 83 patients admitted to our service with acute intracerebral hemorrhage (ICH) were investigated retrospectively; 41 patients with histologically proven diagnosis of cerebral amyloid angiography and 42 patients with clear history of hypertension were investigated. Results: Patients with a CAA-related ICH were significantly older than patients with a HTN-related ICH (74.0years vs 66.5 years, P＜0.05). There was a significantly higher number ofhematomas≥30 ml in CAA (85.3%) when compared with HTN (59.5%). No basal ganglional hemorrhage was seen in CAA, but in 40.5% in HTN. In CAA-related ICH, subarachnoid hemorrhage (SAH) was seen in 26 patients (63.4%) compared to only 11 patients (26.2%) in HTN-related ICH.Intraventricular hemorrhage was seen in 24.4% in CAA, and in 26.2% in HTN. Typical features of CAA-related ICH included lobar distribution affecting mainly the lobar superficial areas, lobulated appearance, rupture into the subarachnoid space, and secondary IVH from the lobar hemorrhage. More specifically, multiplicity of hemorrhage, bilaterality, and repeated episodes also strongly suggest the diagnosis of CAA. Multiple hemorrhages, defined as 2 or more separate hematomas in multiple lobes, accounted for 17.1% in CAA-related ICH. Conclusion: There are certain features in CAA on CT and MRI and in clinical settings. To some extent, these features may contribute to distinguishing CAA from HTN related ICH.     

Non-occupational lead exposure and hypertension in Pakistani adults

INTRODUCTION Blood-Pb levels are taken as representative of dose/exposure, as all clinical symptoms resulting from the toxic effects of Pb are manifested mainly in blood. Lead exposure of children correlates with de- creased IQ, symptoms of hyper kinesis or minima brain dysfunction, poor learning, or defects in specific neuromotor tasks (Landgrin et al., 1980). Large number of observations over the years has associated lead exposure with human diseases (McMichael and Johnson, 1982). Ca…     

Effects of atorvastatin on vascular remodeling in spontaneously hypertensive rats

Objective: To investigate the structural changes of aorta, and evaluate the effects of atorvastatin on the remodeling of thoracic aorta in spontaneously hypertensive rats (SHR). Methods: Twelve eight-week-old SHR were randomized into atorvastatin treated group (ATV group,n=6) and distilled water group (DW group,n=6); Wistar-Kyoto rats (WKY) were used as normal controls. Atorvastatin was administered to ATV group for 10 weeks by gavage in mixture with distilled water(1 ml); the latter two groups were given the same amount of distilled water by gavage for 10 weeks. Systolic blood pressure of caudal artery was examined before and after treatment, and serum concentrations of total cholesterol, triglycerides and HDL-C were measured. Wall thickness, media thickness, medial cross-sectional area and lumen diameter of thoracic aorta were assessed with computed video processing. Results: Systolic blood pressure in ATV group was markedly lower than that in DW group (P<0.01). Compared with DW group and WKY group, serum concentrations of total cholesterol, triglycerides and HDL-C in ATV group were significantly lower (P<0.01,P<0.05). Wall thickness, media thickness, and medial cross-sectional area to lumen ratio in DW group were significantly higher than those in WKY group and ATV group (P<0.01,P<0.05), but no such difference was found between WKY group and ATV group (P>0.05). Conclusion: Vascular structural changes of aorta are due to the alteration of the vessel wall in early stage of SHR. Atorvastatin can markedly improve vascular remodeling.